Head tilt test is useful in diagnosing cyclovertical muscle palsy, especially superior oblique palsy, In this study, we observed efficacy and pattern of head tilt test in 12 patients of unilateral superior oblique palsy(7 congenital, 4 traumatic and 1 vascular) who had abnormal head tilt to nonparetic side. The results of head tilt test were compared to preoperative status in 8 patient, 3 month after surgery. All patients in this study showed positive response of head tilt test. Among them, 9 patients showed definite elevation of paretic eye. However, 2 patients mainly showed definite depression of nonparetic eyes that were amblyopic. The last patient did not show definite vertical deviation in either eye but complained of increasing diplopia. After surgery, abnormal head tilt and positive head tilt response disappeared in 7 patients. In conclusion, preoperative head tilt test is one of the valuable methods in diagnosisng unilateral superior oblique palsy especially in young patients and in those who developed spread of comitance. In addition, the positive head tilt test does no always mean the elevation of paretic eye.
Depression ; Diplopia ; Head* ; Humans ; Paralysis*

STUDY DESIGN: We report two cases of symptomatic spinal epidural lipomatosis (SEL) associated with long-term use of steroid medication OBJECTIVES: The purpose of this study was to assess the clinical characteristics, diagnosis and treatment of symptomatic spinal epidural lipomatosis. SUMMARY OF LITERATURE REVIEW: Spinal epidural lipomatosis is a condition in which excess adipose tissue is deposited circumferentially about the spinal cord in the epidural space. It can present neurologic symptoms including back pain, radiculopathy or cauda equina. Magnetic resonance imaging is the most helpful dignostic means and should be used initially if suspected. Treatment is decompressive laminectomy and debulking of fat. MATERIALS AND METHODS: Two cases of lumbar epidural lipomatosis with neurologic symptoms were discussed and evaluated by physical examination, postmyelography CT and MRI. RESULTS: Two cases were treated with decompressive laminectomy and debulking of fat. Increased accumulation of the fatty tissue was seen predominently in posterior and posterolateral epidural space of the spinal canal, displacing and compressing the lumbar spinal cord anteriorly. Both gross and histologic evaluation revealed overgrowth of unencapsulated normal appearing fat consistent with spinal epidural lipomatosis. One case was demonstrated gradual improvement in symtoms after operation but the other was died due to medical problems. CONCLUSION: The authors reviewed the literature and reported the results of operative treatment of patients with lumbago, radicular pain and intermitent claudication caused by epidural lipomatosis of lumbar spine and degenerative spinal stenosis.
Adipose Tissue ; Back Pain ; Cauda Equina ; Diagnosis ; Epidural Space ; Humans ; Laminectomy ; Lipomatosis* ; Low Back Pain ; Magnetic Resonance Imaging ; Neurologic Manifestations ; Physical Examination ; Radiculopathy ; Spinal Canal ; Spinal Cord ; Spinal Stenosis ; Spine

Glioblastoma multiforme (GBM) is located most frequently in the cerebral hemispheres. Glioblastoma presenting as an extraaxial mass of cerebellopontine angle (CPA) is very rare in adults. We report a rare case of GBM arising in the CPA. The patient was a 71-year-old female, who complained of progressive gait disturbance and poor memory. Initial magnetic resonance imaging (MRI) revealed a 1.4×1.3 cm mass in the left CPA, with broad base to the petrous bone, showing homogenous enhancement. Follow-up MRI showed a rapid increase in size of mass (2.7×2.2 cm) with a necrotic portion. A stereotactic biopsy was done under the guidance of navigation system, and the histopathologic diagnosis was GBM, World Heath Organization grade IV. Further surgical resection was not performed considering her general condition, and the patient underwent concurrent chemotherapy with radiation therapy. Although rare, the possibility of glioblastoma should be included in the differential diagnosis of atypical CPA tumor.
Adult ; Aged ; Biopsy ; Cerebellopontine Angle* ; Cerebrum ; Diagnosis ; Diagnosis, Differential ; Drug Therapy ; Female ; Follow-Up Studies ; Gait ; Glioblastoma* ; Humans ; Magnetic Resonance Imaging ; Memory ; Petrous Bone

Generalized narrowing of the retinal vessels has been recognized for glaucomatous and nonglaucomatous optic neuropathies. To evaluate how closely peripapillary retinal vessel diameters were related to functional and structural optic nerve damage in primary open-angle glaucoma, the data of the vessel diameters were correlated with intra- and peripapillary morphometric parameters and visual field indices. The diameters of the superior temporal and inferior temporal retinal artery and vein were measured at the opticdisc border from optic disc photographs of 234 eyes of 141 patients with primary open-angle glaucoma and 139 eyes of 86 normal subjects. Only one eye per patient and subject was taken for statistical analysis. The diameters of the inferior temporal and superior temporal retinal artery were significantly correlated with the intrapapillary parameters, the peripapillary parameters and the visual field indices. The correlation coefficients were highest for the neuroretinal rim data (r>0.37, p=0.0001), followed by mean deviation, vertical cup to disc ratios, whereas total peripapillary atrophy data, zone beta and zone alpha data were relatively low. Concerning the vessel diameter, the highest correlation coefficients were calculated for the inferior temporal artery, followed by the superior temporal artery. No correlation was found with age and refraction. The results indicate that, in primary open-angle glaucoma, the vessel diameter redduces with decreasing area of the neuroretinal rim, increasing visual field defects and increasing peripapillary atrophy. Its evaluation can be helpful for the diagnosis of glaucoma and possibly also for follow-up.
Atrophy ; Diagnosis ; Glaucoma ; Glaucoma, Open-Angle ; Humans ; Optic Nerve Diseases ; Optic Nerve* ; Retinal Artery ; Retinal Vessels* ; Retinaldehyde* ; Temporal Arteries ; Veins ; Visual Fields

PURPOSE: To investigate the incidence, demographic features and clinical characteristics of polypoidal choroidal vasculopathy (PCV) in Korean patients. METHODS: We retrospectively reviewed the medical records of 413 patients (485 eyes) diagnosed with choroidal neovascularization in exudative age-related macular degeneration between June 2001 and September 2005. All patients underwent complete ophthalmologic examination, fluorescein and indocyanine green angiography, and optical coherence tomography. RESULTS: Among a total of 485 eyes of 413 patients, 80 eyes of 66 patients (16.5%) were diagnosed with PCV. Men were predominantly affected (80.3%), and most patients were elderly with a mean age of 68.3 years (range, 50~93 years) and unilaterally involved (78.8%). The polypoidal lesions in PCV tended to be located in the macula area (62.5%). With respect to vascular network, fine vascular networks were observed in 51 eyes (63.7%) and large lesions were present in 16 eyes (20.0%). Clusters of grape-like polypoidal lesions (60%) were more common than solitary aneurysmal dilations (35.0%). Branching choroidal vessels were present in 67 eyes (83.7%) and absent in 13 eyes (16.3%). Optical coherence tomographic images of polypoidal lesions in 53 eyes showed uneven surfaces with more sharply peaked shapes different from those seen in the serous pigment epithelial detachment in age-related macular degeneration and central serous chorioretinopathy. CONCLUSIONS: The incidence of PCV in Korean patients was relatively high among various ethnic groups. Although the demographic and clinical features of PCV in Korea differed from Caucasian patients, they were similar to Japanese and Chinese patients.
Aged ; Aneurysm ; Angiography ; Asian Continental Ancestry Group ; Central Serous Chorioretinopathy ; Choroid* ; Choroidal Neovascularization ; Ethnic Groups ; Fluorescein ; Humans ; Incidence ; Indocyanine Green ; Korea ; Macular Degeneration ; Male ; Medical Records ; Retrospective Studies ; Tomography, Optical Coherence

An adenoid cystic carcinoma of the lacrimal gland is the most common epithelial neoplasms in lacrimal gland. But it is rare in clinical practice and is poor prognosis below 50% at 2 year survival rate with various clinical management. We experienced a case of a 62-year-old woman who had complained just proptosis and no other tumor symtoms. Being different from the other adenoid cystic carcinoma of the lacrimal gland, MRI revealed mass of the right superiotemporal lacrimal gland which was well demarcated and displaced in nasal area to the optic nerve and no metastasis to adjacent nerves and bones. We performed the lateral orbitotomy followed by macroscopical complete resection of tumors. The histopathologic findings revealed the adenoid cystic carcinoma of the lacrimal gland and were showed variable. So we would report our case with a brief review of the literature.
Adenoids* ; Carcinoma, Adenoid Cystic* ; Exophthalmos ; Female ; Humans ; Lacrimal Apparatus* ; Magnetic Resonance Imaging ; Middle Aged ; Neoplasm Metastasis ; Neoplasms, Glandular and Epithelial ; Optic Nerve ; Prognosis ; Survival Rate

The affiliations were published incorrectly.

Isolated fetal ascites may be different from general category of nonimmune hydrops in both prenatal course and prognosis. We experienced one case of isolated fetal ascites of unknown origin treated by in utero ultrasound-directed paracentesis and so present it with brief review of literature.
Ascites* ; Edema ; Paracentesis* ; Prognosis

PURPOSE: The aim of this study was to determine the diagnostic value of serum procalcitonin (PCT) compared with that of C-reactive protein (CRP) and the total white blood cell count (WBC) in predicting bacterial infections in febrile infants <6 months of age. METHODS: A prospective study was performed with infants <6 months of age who were admitted to the Department of Pediatrics with a fever of uncertain source between July and September 2008. Spinal taps were performed according to clinical symptoms and physical examination. Serum PCT levels were measured using an enzyme-linked fluorescent assay. RESULTS: Seventy-one infants (mean age, 2.62 months) were studied. Twenty-six infants (36.6%) had urinary tract infections (UTIs), and 22 infants (31.0%) had viral meningitis. The remaining infants had acute pharyngitis (n=1), herpangina (n=1), upper respiratory tract infections (n=7), acute bronchiolitis (n=8), acute gastroenteritis (n=4), and bacteremia (n=2). The median WBC and CRP levels were significantly higher in infants with UTIs than in infants with viral meningitis. However, there were no differences in the median PCT levels between the groups (0.14 ng/mL vs. 0.11 ng/mL, P=0.419). The area under the receiver operating characteristic curve was 0.792 (95% CI, 0.65-0.896) for WBC, 0.77 (95% CI, 0.626-0.879) for CRP, and 0.568 (95% CI, 0.417-0.710) for PCT. An elevated WBC count (>11,920/microliter) and an increased CRP level (>1.06 mg/dL) were significant predictors of UTIs based on multiple logistic regression analysis. CONCLUSION: Serum PCT concentrations should be interpreted with caution in infants <6 months of age with a fever of uncertain source.
Bacteremia ; Bacterial Infections ; Bronchiolitis ; C-Reactive Protein ; Calcitonin ; Fever ; Gastroenteritis ; Herpangina ; Humans ; Infant ; Leukocyte Count ; Logistic Models ; Meningitis, Viral ; Oligopeptides ; Pediatrics ; Pharyngitis ; Physical Examination ; Prospective Studies ; Protein Precursors ; Respiratory Tract Infections ; ROC Curve ; Spinal Puncture ; Urinary Tract Infections

PURPOSE: To evaluate changes in subfoveal choroidal thickness in patients with malignant hypertension. METHODS: A total of 12 eyes of six malignant hypertension patients were included in the present study. Intraocular pressure, blood pressure (systolic and diastolic), and choroidal thickness were measured before and after blood pressure control. Choroidal thickness was measured using enhanced depth imaging optical coherence tomography (EDI-OCT). The changes in choroidal extravascular density of the EDI-OCT image after blood pressure control were evaluated by comparing brightness values obtained with Adobe Photoshop software. RESULTS: The subfoveal choroidal thickness (SFCT) of malignant hypertension patients was 412.63 +/- 66.55 microm (mean +/- SD), which was thicker than in normal patients. After blood pressure control, SFCT decreased significantly to 356.96 +/- 59.08 microm (mean +/- SD) (p = 0.002). The choroidal extravascular density of the EDI-OCT image decreased after blood pressure control (p = 0.002), and the mean change was 17.21 +/- 7.56. CONCLUSIONS: The choroid is thickened in patients with malignant hypertension, and its thickness decreases after blood pressure control. This suggests that changes in blood pressure may affect choroidal thickness.
Blood Pressure ; Choroid* ; Humans ; Hypertension, Malignant* ; Hypertensive Retinopathy ; Intraocular Pressure ; Tomography, Optical Coherence